Liver transplantation (LTX) for patients with alcoholic liver disease (ALD) has remained one of the most controversial issues in the arena of liver transplantation. From the beginning, these patients were considered to be less desirable candidates due to the belief that their post-LTX alcohol relapses would cause graft failure, alcohol related health problems, and premature death. Even after two decades of liver transplantation, these questions about the consequences of post-LTX alcohol use remain unanswered. Reports from large datasets suggest that ALD LTX recipients may have health outcomes that could be associated with post-LTX alcohol consumption [1,2] although the rates and patterns of alcohol consumption have not been collected to investigate this connection. We now have a unique and unparalleled opportunity to study the long-term health outcomes of ALD LTX recipients. Through an NIAAA K23 award, Dr. DiMartini has prospectively followed 151 ALD LTX recipients transplanted between 1998 and 2002 and has collected over 4 years of post-LTX data on their alcohol consumption rates and patterns of use. We propose to follow this cohort an additional five years resulting in ALD LTX recipients with longitudinal data from 5 to 10 years post-LTX. From this detailed work we will be able to not only continue to identify alcohol use patterns over the long-term, but most importantly, and most critical to studies of these patients, we will be able for the first time to analyze the effects of specific levels of post-LTX alcohol use on health outcomes. Thus the purpose of our proposed study is to (a) identify the long-term rates of alcohol use in ALD LTX recipients and (b) to identify the degree to which their alcohol use post-LTX increases morbidity and mortality. Interviews with patients and caregivers, medical record reviews, and laboratory data will be collected longitudinally. In addition to resolving critical issues for ALD LTX recipients, we will identify when these patients are at greatest risk to relapse and identify the levels of alcohol use that are deleterious to health, and from these results, will be able to structure clinical services for post-LTX health maintenance and prevention of poorer health outcomes. We also expect to use these data to develop treatment intervention studies for the future.